LIFE MEMBERSHIP APPLICATION FORM

DETAILS OF THE APPLICANTS:(Please write in Capital letters)

Name in Full(surname first):
Previous Name(if married):
Date of Birth(MM/DD/YYYY):
Permanent Address:
Address For Correspondence:
Telephone No(with STD Code):
E-mail Address:
If a student member of AIOTA, refer to the Student Membership #:
Name of Degree:
Name of the Institution:
Month/Year of Graduation:
Other Qualification (PG, PGDR etc):

IF EMPLOYED:

Designation:
Name & Address of the Employing Authority:
Telephone No:
Field of Work:
Upload Membership Application Form:
Upload Internship Completion Certificate:
Upload College Leaving Certificate:
Upload Character Certificate from OT College:
Upload University Degree or Provisional Degree certificate:
Upload one extra color passport size photo:
SUBSCRIPTION & LIFE MEMBERSHIP POLICIES
(The following information’s & regulations has been updated on 1st April, 2017) (TO BE RET AINED BY THE MEMB ER)
1) The MEMBERSHIP FEES (w. e. f. from 1st April, 2017) are as follows:

a) Life Membership Rs. 8000/- + Application Charge Rs. 500/- = Total Rs. 8500/-
b) Urgent Life Membership Fee Rs.12000/-plus application charges Rs.500/-(Membership shall be given within 15 working days)
c) Renewal of Membership Fee- Rs. 5000 & if late to Renew- Rs. 5500
d) Overseas Life Membership US $ 500 + including application charges in its equivalent Indian Currency at the rate in force at the time of submission.
e) Renewal of NRI Life Membership Fee- US $300 & If late to Renew- US $350
f) Provisional Membership Fee: Rs.8000/-+ Rs.500/-

2) The Life Members are entitled to voting rights.

3) Membership fees will be accepted by Demand Draft only, drawn at any Nationalized Bank, drawn in favor of ALL INDIA OCCUPATIONAL THERAPISTS’ ASSOCIATION payable in MUMBAI, MAHARASHTRA.

4) Any future changes in address or contact nos., names should be intimated immediately to the AIOTA Web Administrator for necessary corrections on the AIOTA Mailing list.

5) Non- receipt of AIOTA Communication should be brought to the notice of AIOTA Web Administrator/Editor-in-Chief IJOT immediately.

6) On becoming the Life Member, the member shall receive one Membership Certificate, ACOT Registration Certificate, Membership Card and an AIOTA Badge.

7) On becoming the Life Member, the member will be entitled to receipt of complimentary copies of Indian Journal of Occupational Therapy, concession in the registration fees and allow to participate in National OT Conferences or other workshop organized by AIOTA, contest for the Executive Body of AIOTA and will be eligible for obtaining License Verification & Letter of Good Standing for jobs abroad.

8) No photocopy of the form will be accepted, only original print on A4 size Executive Bond paper will be accepted.

9) The applicant to sign across the affixed photo.

10) Graduates from AIOTA recognized OT schools can only apply for Life Membership. The filled in Membership Form to be submitted at the Honorary Treasurer’s Office. The contact details
Dr. Pratibha M.Vaidya
Hon. Treasurer (AIOTA)
O.T. School & Centre
T.N.Medical College & BYL Nair Ch.Hospital
OPD 21 , M Bldg.
Dr. A.L Nair rd
Mumbai Central
Mumbai 400 008
M:09821536404 (call timing 6pm to 10pm)
Ph(R):91-022-28982208
Official Email id :treasurer@aiota.org
Personal Email id: pmv25@rediffmail.com

11) the life members will have access to membership directory on www.aiota.org and one page will be dedicated to the member with prescribed information.

12) The Life Membership will be valid for a specified duration and will not hold good after the specified term. Currently it is 15 years of uninterrupted life membership.

13) The following ATTESTED CERTIFICATES should be submitted along with the duly filled Life Membership Application Form without which the form will not be accepted:

1. Internship Completion Certificate
2. College Leaving Certificate
3. Character Certificate from OT College
4. University Degree / Diploma Certificate or Provisional Degree/Diploma Certificate.
5. One extra passport size photo (45mm X 35mm).
6. The Demand Draft of the prescribed amount.